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ACA Exchanges are Dysfunctional

The Supreme Court is expected to rule on King v. Burwell in June. At issue is whether the Affordable Care Act as written only allows for federal subsidies to go to enrollees in states that operate their own exchanges. Right now, 34 states rely on the federal government to operate the exchanges, meaning a significant amount of subsidies are on the line.

If the Supreme Court strikes down the federal subsidies, some Governors and State Legislatures may rush to set up an exchange in order to retain them. Before making any decisions, however, they should be well aware of some of the miserable conditions state exchanges are currently imposing on officials.

Here is a brief summary of some of those states.

California’s exchange is facing an $80 million deficit for its 2015-16 fiscal year, even though the law requires it to be self-sustaining. According to the Orange County Register, this year “just might prove to be the tipping point for the state’s two-year-old health insurance exchange.” Enrollment has disappointed officials. In fact, 2015 enrollment grew by just 1 percent. California also had the fourth lowest re-enrollment rate in the country at 65 percent. As the OCR stated, “if it continues to run yearly operating deficits, it will not long survive.”

Oregon’s experience with an exchange was so miserable that they recently voted to scrap it and allow the federal government to run the exchange. It cost the state $248 million but “no Oregonian was ever able to enroll online in a private plan…because the state exchange never had a functioning website, forcing insurance seekers to file paper applications,” according to the LA Times. Prior to that vote, Cover Oregon was facing a deficit of $2 million.

ObamaCare exchanges are more burdensome on state governments than many people ever expected. State legislatures and Governors have plenty of good reasons not to set one up even if it prevents federal subsidies from flowing to their states.

The text of the amendment negotiated by Rep. Tom MacArthur (R-N.J.), a co-chair of the moderate Tuesday Group, and Rep. Mark Meadows (R-N.C.), the chairman of the House Freedom Caucus, has been published by The Hill. As expected, the amendment would allow states to submit a waiver application to the Secretary of the Department of Health and Human Services for the community rating and the essential health benefits provisions of ObamaCare.

Rep. Ted Budd (R-N.C.) is new to the world of politics. His commitment to really repealing Obamacare was on full display as Speaker Paul Ryan pushed his health care bill. What he says is not just words. His behavior made that clear in the recent healthcare debate.

It's often said that House Republicans have voted to repeal ObamaCare more than 50 times since taking control of the lower chamber in January 2011. Such rhetoric isn't an entirely accurate picture of the votes the House has taken. Yes, it's true that there have been more than 50 votes to repeal, defund, or delay either the entire law or parts of it, but there have been relatively few votes to fully repeal or delay ObamaCare.